Attachment 3-Past Performance Evaluation Survey.docx

CONTROLLED UNCLASSIFIED INFORMATION(CUI)

When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

Past Performance Questionnaire – Sample 1 USACE San Francisco District (SPN) is in the process of competitively selecting a source for Elevator Maintenance, Repair and Inspection Service. SPN has a requirement for Elevator Equipment Maintenance, Repair, and Inspection services for Warms Springs Dam and Coyote Valley Dam, CA.

One of the considerations in proposal evaluation is the verification of the offerors' past performance on contracts or other work efforts which reflect the offeror's ability to perform on the proposed effort. We depend on information received from organizations such as yours, which have had first-hand experience with the offeror, for the evaluation of the offeror's performance on those contracts or work efforts.

Our areas of interest regarding the offeror are summarized in the enclosed questionnaire. In order to meet the acquisition milestones, we request your written response no later than response date and time of the solicitation.

To assist you in preparing your response and expediting your reply, the questionnaire may be filled out electronically and e-mailed to james.neal@usace.army.mil AND suntok.mcguinness@usace.army.mil. Your completed questionnaire will become a part of the official Source Selection records.

Your assistance is greatly appreciated, and your prompt response will be one of the keys to the successful and timely completion of this Source Selection.

Encls -1 Past Performance Questionnaire

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Program Description:

G. Program Phase (e.g., Engineering & Manufacturing Development (EMD)):

H. Period of Performance

1. Original Schedule (assuming all options exercised):

Beginning Date _________ through ____________

2. Current Schedule (assuming all options exercised):

Beginning Date _________ through ____________

3. Reason for difference (if applicable):

I. Contract Dollar Value

1. Original maximum contract dollar value (assuming all options exercised): $

2. Current maximum contract dollar value (assuming all options exercised): $

3. Reasons for difference between original and current contract dollar value (if applicable):

J. Description of work performed:

K. Was this a competitively awarded contract? ☐ Yes ☐ No

L. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor ☐ Key Personnel

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of services under this contract (i.e., local, nationwide, worldwide, other Commands):

D. Customer email:

E. Customer phone # CUI Page 8 of 8